McDowell P Jane, Redmond Charlene, Busby John, Patel Pujan, Jackson David J, Pfeffer Paul E, Mansur Adel H, Patel Mitesh, Brown Thomas, Burhan Hassan, Chaudhuri Rekha, Rupani Hitasha, Heaney Liam G
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引用次数: 0
摘要
背景：重度哮喘生物治疗的目的是抑制T2炎症通路。目的：我们假设通过生物治疗实现IL-5和il - 4/IL13通路完全抑制的患者（FeNO）方法：回顾性分析英国严重哮喘登记处（UKSAR）中符合严格的国家生物制剂准入标准的严重哮喘患者。比较生物缓解（BR）和非生物缓解（BR）的生物学前和年度回顾的特征。结果：778例患者中，有BR 148例（19%），无BR 630例（81%）。BR在减轻加重、口服类固醇暴露、肺功能改善、症状改善或t2生物标志物降低方面没有额外的益处。在开始使用生物制剂之前，BR队列的t2高水平较低。病程长（adjOR 1.96, 95% CI 1.17至3.28）、大环内酯类药物治疗（adjOR 2.08, 95% CI 1.17至3.71）和吸烟史（adjOR 1.63, 95% CI 1.11至2.39）是BR的阳性预测因子，而高t2生物标志物预测非BR。而BEC和FeNO均与肺功能呈负相关。结论：与未行BR的患者相比，行BR的患者没有更好的预后。BR表示T2疾病负担较低的患者队列和驱动疾病严重程度的其他因素。然而，抑制T2生物学对于肺功能的获得是重要的。需要对完全抑制t2复合高患者IL5和IL4/13通路的治疗策略进行前瞻性评估。
Observational analysis of biological remission as a treatment target for severe asthma: UK severe asthma registry.
Background: The aim of biologic therapies in severe asthma is inhibition of T2 inflammatory pathways.
Objective: We hypothesized that patients who achieve complete suppression of IL-5 & IL4/IL13 pathways with biologic therapy (FeNO <20ppb & blood eosinophil count (BEC) <0.15x10ˆ9, 'biological remission') would have better outcomes than patients with incomplete suppression of T2 biology.
Methods: Retrospective analysis of severe asthma patients in the United Kingdom Severe Asthma Registry (UKSAR) who met strict national access criteria for biologics. Characteristics pre-biologic & at annual review were compared across biological remission (BR) & non-BR.
Results: Of 778 patients, 148 (19%) had BR and 630 (81%) non-BR. BR did not confer additional benefit in exacerbation reduction, oral steroid exposure, lung function improvement, symptom improvement or T2-biomarker reduction. The BR cohort were less T2-high prior to commencing biologics. Long disease duration (adjOR 1.96, 95% CI 1.17 to 3.28), macrolide therapy (adjOR 2.08, 95% CI 1.17 to 3.71), & smoking history (adjOR 1.63, 95% CI 1.11 to 2.39) were positive predictors of BR, while higher-T2 biomarkers predicted non-BR. However, BEC & FeNO both had a negative correlation with lung function.
Conclusion: Patients who achieve BR do not have superior outcomes compared to those who do not achieve BR. BR denotes a cohort of patients with a lower burden of T2 disease & additional factors driving disease severity. However, suppression of T2 biology is important for lung function gain. Prospective evaluation of treatment strategies that completely supress IL5 & IL4/13 pathways in T2-composite high patients is needed.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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